PSY240H1 Chapter Notes - Chapter 12: Histrionic Personality Disorder, Paranoid Personality Disorder, Diagnostic And Statistical Manual Of Mental Disorders

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Published on 25 Jun 2011
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UTSG
Department
Psychology
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PSY240H1
Professor
Chapter 12 Personality Disorders
Personality- is all the ways we have of acting, thinking, believing, and feeling that
make each of us unique, and a trait is a complex pattern of behaviour, thought, and
feeling that is stable across time and across many situations
Defining and Diagnosing Personality Disorders
A Personality Disorder is a long standing pattern of maladaptive behaviours,
thoughts and feelings
-In order to to be diagnosed, the symptoms must have been around since childhood,
and be harmful to everyday life causing significant distress
-These disorders are controversial because of the conceptualization of the disorder
and the assessment
-The DSM gives it special treatment because it is on Axis II and not on Axis I, like many
other psychotic disorders such as schizophrenia and major depression
-People often with a personality disorder often experience one or more acute disorders
such as major depression or substance abuse
-People with personality disorders do not usually seek treatment unless it is for
something else like depression or because their substance abuse has landed them in
prison
-The criteria for assessing these disorders are a lot vaguer than other disorders so,
there is more room for error
-The pervasive nature makes it a lifelong pattern that!s why it is on Axis II
The DSM
Enduring pattern of behaviour that is pervasive and inflexible, as well as, stable and of
long duration
Causes clinically significant distress or impairment in functioning
Manifests in at least 2 of the following: cognition, affectivity, interpersonal functioning
or impulse control
Must show symptoms since adolescence or early adulthood
Problems with DSM
1. Symptoms are treated as if they are discrete categories when they are often only
extreme versions of otherwise “normaltraits. What!s abnormal? So it doesn!t take
into account the dimensionality of the trait
2. Overlap in the diagnostic criteria and the majority of people who are diagnosed with
one disorder tend to meet the diagnostic criteria for at least one other personality
disorder. What is the category for two or more criteria?
3. Diagnosing a personality disorder often requires information that is hard for a
clinician to obtain. They might not be able to provide the history, so it!s not reliable
4. Conceptualized as stable characteristics, yet they vary, so individuals go in and out
of the diagnosis, e.g when a person is suffering from an Axis I disorder such as
major depression, it may seem as if they are suffering from personality disorder, so
when they get treatment and their Axis I disorder seems to diminish, so does their
personality disorder
This may also make it difficult to diagnose and be reliable, and difficult to do research
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Gender and ethnic Biases
Differences in frequencies with which men and women and individuals of minority
groups are diagnosed with different personality disorders does this reflect bias and
an application of negative stereotypes?
Lack of recognition that the expressions of symptoms of a disorder may vary between
women and men.
Lack of recognition that the expressions of symptoms of a disorder may vary between
groups.
sometimes more men are diagnosed with one disorder than women and vice versa, so is this a
true distinction or just a bias?
Personality disorder maybe seen as being an extreme version of female personality and
clinicians are quick to diagnose but males face the same situation with antisocial personality,
paranoia, and OCD and males are quick to be diagnosed with this disorder
It maybe that symptoms may naturally vary b/w genders and races (European > other)
Or it may just be that different genders express it differently based on different roles taken in
society, such as a male showing his symptoms against society, or female against her kids
Another possibility is because of the DSM downplays masculine ways of expressing which
contributes to it being under diagnosed, as the DSM sees male expression of personality
disorder as acting “macho” and bragging about athletic skills, so clinicians may be too quick to
see histrionic, dependent, and borderline personality disorders in women and anti-personality
in men, in fact a study showing that when the profile of someone exhibiting these symptoms,
say of histrionic disorder than, the person is more likely to be described as female than male
Critics of personality disorder say that structured interviews rather than unstructured interviews
should be used to asses because it makes it more fair, and show less gender biases, but yet even
still more women are diagnosed with certain personality disorders, (e.g histrionic) over others
Structured interviews and self-reports produce similar diagnoses among ethnic groups, so the
clinicians do not just show bias
Some argue that criteria should be balanced to include equal numbers of symptoms and
diagnoses that are pathological variants of male and female, and the DSM should do a better
job of balancing male and female
Subtypes of Personality Disorders
Cluster A: Odd-Eccentric Personality
Disorders
Symptoms similar to those for
schizophrenia, including inappropriate or
flat affect, odd thought and speech
patterns, paranoia. People with these
disorders maintain their grasp on reality,
however. There is still a general grasp of
reality, unlike schizophrenia where there is
an lack of touch with reality
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Cluster B: Dramatic-Erratic Personality
Disorders
Manipulative, volatile, and uncaring in
social relationships. Impulsive, sometimes
violent behaviour that show little regard for
their own safety or the safety or needs of
others, such as histrionic, narcissistic
Cluster C: Anxious-Fearful Personality
Disorders
Extremely concerned about being criticized
or abandoned by others and thus have
dysfunctional relationships with them.
Avoidance, dependent, OCPD
The Odd-Eccentric
Three main types :
5. Paranoid personality disorder Chronic and pervasive mistrust and suspicion of
other people that is unwarranted and maladaptive.
-it has a weak relationship with schizophrenia
-Believe people are chronically trying to deceive or exploit them for confirming
evidence of suspicions
-Misinterpret or Overinterpret situations in line with their suspicions e.g. wife!s
cheerfulness = she!s having an affair
-Resistant to rationale arguments against their suspicions
-Withdrawal from others in order to protect themselves
-Prevalence estimates are between .5 -5%
-Males > Females
-Acute psychological problems: major depression, anxiety, substance use
DSM
I) Evidence of pervasive distrust or suspiciousness of others present in at least 4 of
the following ways:
a.Pervasive suspiciousness of being deceived, harmed, or exploited
b.Unjustified doubts about loyalty or trustworthiness of friends or associates, or ppl not
close to them
c.Reluctance to confide in others because of doubts of loyalty or trustworthiness
d.Hidden demeaning or threatening meanings read into benign remarks or events
e. Bears grudges; does not forgive insults, injuries, or slights
f. Angry reactions to perceived attacks on his or her character or reputation
g.Recurrent suspicions regarding fidelity of spouse or sexual partner
II) Does not occur exclusively during course of Schizophrenia, Mood Disorder with
Psychotic Features, or other psychotic disorder
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Document Summary

De ning and diagnosing personality disorders: a personality disorder is a long standing pattern of maladaptive behaviours, thoughts and feelings. In order to to be diagnosed, the symptoms must have been around since childhood, and be harmful to everyday life causing signi cant distress. These disorders are controversial because of the conceptualization of the disorder and the assessment. The dsm gives it special treatment because it is on axis ii and not on axis i, like many other psychotic disorders such as schizophrenia and major depression. People often with a personality disorder often experience one or more acute disorders such as major depression or substance abuse. People with personality disorders do not usually seek treatment unless it is for something else like depression or because their substance abuse has landed them in prison. The criteria for assessing these disorders are a lot vaguer than other disorders so, there is more room for error.